ABSTRACT
This chapter discusses the clinical manifestations of the OPsP, giving special attention to delusional thinking and to the experience of psychic emptiness; although without neglecting the difficulties of communication in the analytic relationship. Delusional thought is the other consequence of the limited capacity for containing psychic pain. For psychotic patients, communication with the analyst derives from the aforementioned type of internal communication, but it attempts to encompass the latter through intense projections. One of the primary issues in treating psychotic patients is establishing an understandable communication between patient and analyst. In Hanna Segal's work "Phantasy and reality", she starts from S. Freud's statement that recognising external reality is necessary for the development of the psyche, adding that it is inextricably linked to the internal reality of one's own wishes and fantasies. All possible channels of expression are necessary for its release, or, perhaps it would be better to say, its communication.
